Ross Caulum

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PHOENIX-As Scripps Health in Greater San Diego continues to deploy a strategy of providing healthcare in non-hospital settings, it is finding that it needs to be versatile in the types of facilities and services it provides throughout its service area.

That’s because the communities served by the five-hospital, 13,000-employee Scripps system vary greatly. For example, one of its hospitals is in La Jolla, an extremely affluent seaside resort community of slightly more than 40,000 people about 12 miles north of downtown San Diego. Another is in Chula Vista, a fast-growing, highly diverse community of almost a quarter-million residents just seven miles from the Mexican border.

As a result, the not-for-profit system’s outpatient strategy, otherwise known as an ambulatory care model, is “an emerging platform” that might ultimately look different than how it looks now, according to Ross Caulum, senior director, corporate real estate. At the recent RealShare Medical Office Buildings Conference in Scottsdale, AZ, Caulum told those in the audience that the system is likely to rely somewhat on real estate professionals to help it reach its goal.

He said the system is seeking to provide a continuum of care with quality and affordability in conveniently located “retail-like” locations and to arm the facilities with the proper technology. “Like many providers, we’re trying to make that switch from a hospital silo-centric, doctor-centric system, to an ambulatory-centric system,”  Caulum commented. “A lot of people talk about ‘core’ being the hospital,” he added, but he suggested people reconsider that. “Core is not hospital. Core will be ambulatory. And that evolution is going to take many, many years to happen,” he noted.

The system needs to get a handle on how to move from a network of ‘70s era, “locationally and functionally obsolete MOBs that now have to help deliver healthcare in today’s environment.” He questioned whether it is even possible for some older MOBs to be retrofitted for today’s needs.

As a result, Scripps is wrestling with the question of how to rebuild its entire acute-care model to create an ambulatory environment in which it can provide care for a wide range of patients all the way from La Jolla to Chula Vista. It must do so, he noted, in an era of dwindling federal reimbursements.

“It’s a balancing act and that’s where I think you all come in,” he told the crowd, adding that some of them could perhaps help Scripps “figure out how to do that demographic healthcare best practice. How do we physically, efficiently have a design? How do we cost-effectively deploy our capital?”

The big question for real estate people, he said, is “Where’s the place?” The answer will not be “one-size fits all” because markets vary.

The Scripps’ model of integrated medicine and accountable care emphasizes the co-management of services by physicians and administration, Caulum said. Scripps seeks to give physicians the technology and data they need to make good decisions while reducing costs. The system is also working to standardize care, moving it into an ambulatory network with integrated technology.

As for whether Scripps plans to keep expanding, Caulum said only that the system continues to look at and evaluate plenty of opportunities.

John Mugford is the Editor of Healthcare Real Estate Insights, the nation’s first and only publication totally dedicated to covering news and trends in healthcare real estate development, financing and investment. For more information, please visit